by Tim Lacy

What is a microaggression? From where did the term arise? How does it work in medical education?

A microaggression is, per Merriam-Webster, “a comment or action that subtly and often unconsciously or unintentionally expresses a prejudiced attitude toward a member of a marginalized group (such as a racial minority).” Microaggressions are, in sum, subtle put-downs based on race, class, gender, sexuality, or disability. They are often “add ons” or qualifications to a point, or an unintended behavior. The offending item is often invisible to the perpetrator, which makes it difficult to convince the person that discrimination, racism, classism, sexism, ableism, or oppression has occurred. Here’s one example from Merriam-Webster:

“A digital photo project run by a Fordham University student about ‘racial microaggressions’ features minority students holding up signs with comments like ‘You’re really pretty … for a dark-skin girl.'”

What created the term? And when? The notion of a microaggression was first invoked in 1970 by Harvard psychiatrist Chester “Chet” Pierce, MD. He died in 2016. Here are two short reflections on his life and work (one and two). The following is an excerpt from the first, by Ezra Griffith, MD:

It took time for me to recognize that Pierce was, in Hazel Carby’s terms, a 20th century “race man” (See H.V. Carby, Race Men, Harvard University Press, 1998). That is to say, like W.E.B. Du Bois and others, Chester Pierce engaged in racialized thinking, constantly focused on the black-white dichotomy and centered on an ideology that was directly related to race matters in this country. He told me of his participation in the 1968 struggle within APA to make clear the black constituency’s dissatisfaction with the white leadership’s modest interest in blacks and their concerns. But he never wanted to turn the psychiatric association into a flaming cauldron. He sought no distancing of blacks from whites. He wanted to confront whites frankly and plainly, without excessive drama, framing his thoughts about black bodies and minds and how they should be treated. It is he who discussed dignity and autonomy with me, emphasizing the salience of blacks’ controlling the development of their own identities. He had come to that paradigm from the intimate examination of the black-white interaction in behavioral studies of large organizations. He had also examined that interaction through engagement with films and extreme environments.

As is clear from this reflection and from the definition, there is, historically, a strong white-to-black vector in microggressions. Over time, to the present, this has expanded to all people of color, and gender and sexuality are part of the conversation.

Controversy about microaggressions occurs when, beyond simply raising awareness and pointing out problematic expressions and behaviors, one moves to shaming and punishing a purported microaggressor. While this may be necessary in relation to repetition after education occurs, in most cases the offender simply needs to be educated about their expressions and actions.

In medical education a microaggression might occur when an instructor calls on white students before people of color. It might occur when the same effort from students of color results in differing assessments or responses from instructors. A microaggression might occur when white students feel free to interrupt fellow students of color while expecting, for their part, to be heard. Class-based microaggressions could involve assumptions about resources, assumed structural knowledge, off-time activities, etc.

A take-away for participants in medical education is to be careful about assumptions. Another is to be open to feedback regarding one’s speech and communications habits. Educators must be conscious of what power dynamics are in play. You can be sure that students are aware, and cautious, about those dynamics. Those who identify perceived microggressions might ask, in a discreet and professional manner, what was meant by a certain comment.  We should all strive to be intentional and, hopefully, calm in public settings with patients and colleagues present.